=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649363979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATIONAL HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 HIGHLAND AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37916-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-525-4131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4407 BARBARA DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-603-4542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COTA/L
-----------------------------------------------------
Name | MS. TONI RENEE EDENFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-603-4542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0162
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------